Abstract

It is a common paediatric problem that needs simple treatment with local cauterization with silver nitrate. This 10 day baby male was admitted to Neonatology Department with peri umbilical ulceration and pigmentation. Clinically it was viewed to be consistent with chemical burns. His mother was allergic to silver. Treatment was conservative, and the outcome was good in the case.

Keywords

Neonatology; Umbilical granuloma; Periumbilical area

Introduction

The most commonly used treatment of umbilical granuloma
is silver nitrate cauterization that comes mounted on a
wooden stick applicator in a concentration of 75% [1-3]. Its use
can result in burns to peri umbilical skin, so caution should be
exercised during application [4-6].

Case Report

A male patient was born in Turkey at 37 weeks of gestation
via lower segment cesarean section delivery with a birth
weight of 3300 g and a length of 50 cm.

His mother was 29 years old and his father was 32 years old,
both were healthy and unrelated. The mother did not use any
medications during pregnancy (Figure 1).

Figure 1: Silver nitrate burns to the periumbilical area.

No prenatal ultrasound scan was performed. There was no
family history of ID or congenital anomalies. The mother was
allergic to silver.

She was referred on the 10th day. On clinical examination,
we noted a umbilical granuloma and chemical burns to the
peri umbilical area. It was found that he once treated with
umbilical granuloma for 75% silver nitrate stick. Treatment was
conservative, and the outcome was good in the case (Figure 2).

Figure 2: Seven days after conservative treatment.

Discussion

It is a common paediatric problem that needs simple
treatment with local cauterization with silver nitrate [7,8]. This
chemical acts as an antiseptic, astringent, or caustic agent
depending on the concentration. This chemical cauterization
has been reported to cause periumbilical Cutaneous burns [9-11]. Careful drying of the umbilical exudate to prevent
spillage is essential in preventing staining of the skin or
chemical burns [12-14]. There have been case reports
documenting burns following silver nitrate application. The
literature reveals that silver nitrate has also been implicated as
the causative agent in contact dermatitis, although it is
generally thought to be a rare occurrence [15-18]. In this case
we thought that silver nitrate burn at the peri umbilical area
could be related to the mother's silver allergy.

Instead of silver nitrate application, it could be a more
rational approach to utilize alternative methods for umbilical
granuloma treatment of babies of the mothers which are
allergic to silver.

Conclusion

For umbilical granuloma treatment of babies of the mothers
which are allergic to metal it will be a wise move to use a
cautious approach while using silver nitrate.